Tools for measuring sexual and reproductive health and rights (SRHR) indicators in humanitarian settings

Goulart, C. M.; Giancola, A.; Nakhuda, H.; Ampadu, A.; Purewal, A.; Kortenaar, J.-L.; Bassani, D. G.

Background: Effective measurement of all health indicators and especially SRHR is difficult in humanitarian settings. Displacement and insecurity due to conflict, natural disasters, and epidemics place women and girls at higher risk of SRHR-related morbidity and mortality and reduce the coverage of essential SRHR services. This scoping review describes the measurement tools, methods, and indicators used to measure SRHR coverage and outcome indicators in humanitarian settings in the past 15 years and presents an accessible dashboard that can be used by governments, researchers and implementing organizations to identify available SRHR measurement tools. Methods: Scientific articles published between January 2004 and May 2019 were identified using Embase, Medline, PsycInfo, CINAHL, Scopus, PAIS index as well as relevant non-peer-reviewed literature available through websites of humanitarian organizations. Publications including data from low- or middle-income countries (LMICs), focused on women and/or girls living in areas impacted by a humanitarian crisis, where data was collected within five years of the crisis were included. Indicators extracted from these publications were categorized according to validated SRHR indicators recommended by the World Health Organization (WHO). Measurement tools, sampling and data collection methods, gap areas (geographical, topical and contextual), and indicators were catalogued for easy access in an interactive Tableau dashboard. Results: Our search yielded 42,081 peer-reviewed publications and 2,569 non-peer-reviewed reports. After initial title and abstract screening, 385 publications met the inclusion criteria. SRHR indicators were categorized into nine domains: abortion, antenatal care, family planning, gender-based violence, HIV and sexually transmitted infections, maternal health, maternal mortality, menstrual and gynecological health, and obstetric care (delivery). A total of 65 tools and questionnaires measuring SRHR were identified, of which 25 were designed specifically for humanitarian settings. Discussion: Although SRHR was measured in humanitarian settings, several gaps in measurement were identified. Abortion and gynaecological health were not consistently measured across included studies or validated WHO indicators. Toolkits and indicators identified in this review may be used to inform future SRHR data collection in humanitarian settings. However, identifying and/or developing innovative data collection methodologies should be a research priority, especially in light of the recent COVID-19 pandemic.